Respiratory Pathology Practice Questions

Q: Rasmussen's aneurysm occurs due to which artery?

Pulmonary artery. **Explanation:** **Rasmussen’s aneurysm** is a clinical phenomenon associated with **chronic cavitary pulmonary tuberculosis**. It refers to an inflammatory pseudoaneurysm of a **pulmonary artery** branch located in the wall of a tuberculous cavity. 1. **Why Pulmonary Artery is Correct:** In chronic tuberculosis, the progressive inflammation and necrosis (caseation) within a lung cavity lead to the thinning and weakening of the adjacent pulmonary arterial wall. As the lung parenchyma is destroyed, the arterial wall loses its structural support and bulges, forming an aneurysm. If this aneurysm ruptures into the cavity, it leads to massive, life-threatening hemoptysis. 2. **Why Other Options are Incorrect:** * **Bronchial Artery:** While bronchial arteries are the most common source of *general* hemoptysis (due to their high systemic pressure), they are not the anatomical site of a Rasmussen’s aneurysm. * **Vertebral Artery:** This artery supplies the brain and spinal cord; it has no anatomical involvement in pulmonary cavitary lesions. * **Posterior Intercostal Artery:** These supply the chest wall and pleura. While they may develop collateral circulation in chronic pleural diseases, they are not involved in the formation of Rasmussen’s aneurysms. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Presentation:** A patient with a history of treated or chronic TB presenting with sudden, voluminous hemoptysis. * **Location:** Usually occurs in the upper lobes (where TB cavities are most common). * **Radiology/Management:** Contrast-enhanced CT (CECT) is the diagnostic tool of choice. The definitive management is often **bronchial or pulmonary artery embolization** or emergency surgery. * **Pathology Note:** It is a *pseudoaneurysm* because the wall is composed of fibrous tissue rather than all three layers of the blood vessel.

Q: Which of the following statements is NOT true regarding Bronchoalveolar carcinoma?

It involves stromal invasion with desmoplasia.. **Explanation:** **Bronchoalveolar Carcinoma (BAC)**, now classified under the spectrum of **Adenocarcinoma in situ (AIS)** and **Minimally Invasive Adenocarcinoma (MIA)**, is unique because of its non-invasive growth pattern. [1] 1. **Why Option B is the correct answer (The "False" statement):** The hallmark of BAC is its **lepidic growth pattern**, meaning the tumor cells "crawl" along the pre-existing alveolar walls without invading the underlying stroma, blood vessels, or pleura. [1] Because there is no stromal invasion, there is **no desmoplastic response** (fibrotic reaction). If stromal invasion or desmoplasia is present, the diagnosis shifts to invasive adenocarcinoma. 2. **Analysis of Incorrect Options:** * **Option A:** BAC is a subtype of **Adenocarcinoma**. [1] It arises from peripheral lung tissue, specifically from Clara cells or Type II pneumocytes. * **Option C & D:** These describe the **Lepidic pattern**. The tumor uses the alveolar septa as a scaffold, preserving the basic lung architecture. [1] This preservation is why BAC often appears as a "ground-glass opacity" or mimics pneumonia on a chest X-ray. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Always peripheral. * **Radiology:** Can present as a single nodule, multiple nodules, or a diffuse "pneumonic" infiltrate. * **Microscopy:** Look for the "butterflies on a fence" appearance (cells lining alveolar walls). [1] * **Prognosis:** It has a significantly better prognosis than other bronchogenic carcinomas because of its non-invasive nature. * **Smoking:** It is the subtype least strongly associated with smoking and is the most common lung cancer found in non-smoking women. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lung, pp. 721-723.

Q: A Pancoast tumor is typically associated with cancer of which of the following structures?

Apical lobe of the lung. **Explanation:** **Pancoast tumor**, also known as a **superior sulcus tumor**, refers to a malignancy (most commonly **Squamous cell carcinoma** [1] or Adenocarcinoma [1]) located at the extreme apex of the lung. 1. **Why Option A is correct:** The tumor arises in the **apical lobe** and extends superiorly to involve the thoracic inlet. Its clinical significance lies in its proximity to vital structures like the brachial plexus and the sympathetic chain [1], rather than the pulmonary symptoms (like cough) usually seen in other lung cancers. 2. **Why the other options are incorrect:** * **Option B (Lingula):** The lingula is a part of the left upper lobe but is anatomically equivalent to the middle lobe and is located inferiorly, far from the superior sulcus. * **Option C & D (Thyroid & Pyriform fossa):** While these are located in the neck/upper aerodigestive tract and can cause local compression, they do not constitute a "Pancoast tumor," which is specifically defined as a primary bronchogenic carcinoma. **Clinical Pearls for NEET-PG:** * **Pancoast Syndrome:** Characterized by the triad of: 1. **Horner’s Syndrome:** Due to involvement of the **cervical sympathetic chain/stellate ganglion** (Ptosis, Miosis, Anhidrosis) [1]. 2. **Brachial Plexopathy:** Specifically the lower trunk (**C8–T1**), leading to pain and weakness in the ulnar distribution of the arm and wasting of intrinsic hand muscles [1]. 3. **Rib Destruction:** Erosion of the first and second ribs [1]. * **Most common histological type:** Squamous cell carcinoma (historically) [1], though Adenocarcinoma is now frequently reported. * **Initial Investigation:** Chest X-ray (shows apical capping/mass); **MRI** is the gold standard for assessing local invasion before surgery. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Respiratory Tract Disease, pp. 334-337.

Question 1

Which of the following statements about small cell carcinoma of the lung is incorrect?

Accepted Answer

It is less associated with paraneoplastic syndromes compared to non-small cell lung cancers.

Answer

It is a poorly differentiated neuroendocrine tumor.

Answer

It usually presents as a central mass.

Answer

Cells show a salt and pepper chromatin pattern.

Question 2

Bronchial hyperplasia may be caused by all of the following except?

Accepted Answer

Theophylline

Answer

Smoking

Answer

Prematurity

Answer

Allergy

Question 3

Following thoracotomy, a lesion is detected in the right lower lung lobe of a 20-year-old man. The lesion is found to be nonfunctioning lung tissue served by vessels separate from those of the adjacent lung tissue. What is the most likely diagnosis?

Accepted Answer

Bronchopulmonary sequestration

Answer

Mesothelioma

Answer

Hiatal hernia

Answer

Glomus tumor

Question 4

Rasmussen's aneurysm occurs due to which artery?

Accepted Answer

Pulmonary artery

Answer

Vertebral artery

Answer

Bronchial artery

Answer

Posterior intercostal artery

Question 5

Which of the following are histological features of pulmonary hypertension?

Accepted Answer

Thrombi in pulmonary vasculature and vaso-occlusive disease and arterial wall thickening

Answer

Capillaritis of alveolar septa and vaso-occlusive disease and arterial wall thickening

Answer

Saddle thrombi in pulmonary trunk and vaso-occlusive disease and arterial wall thickening

Answer

Capillaritis of alveolar septa and vaso-occlusive disease and arterial wall thickening

Question 6

Which of the following statements is NOT true regarding Bronchoalveolar carcinoma?

Accepted Answer

It involves stromal invasion with desmoplasia.

Answer

It is a type of Adenocarcinoma.

Answer

It shows preservation of the alveolar structure.

Answer

It grows along pre-existing anatomical structures.

Question 7

High Reid index is indicative of which disease?

Accepted Answer

Chronic bronchitis

Answer

Pulmonary tuberculosis

Answer

Bronchial asthma

Answer

Emphysema

Question 8

Which of the following statements are true regarding the pathogenesis of bronchitis?

Accepted Answer

All of the above.

Answer

Initiating factor is exposure to noxious stimuli or tobacco.

Answer

Hypersecretion of mucus in large airways.

Answer

Inflammatory infiltrate.

Question 9

Carcinoid tumors typically develop from which of the following cell types?

Accepted Answer

Enterochromaffin cells

Answer

Neuroectoderm

Answer

J cells

Answer

Goblet cells

Question 10

A Pancoast tumor is typically associated with cancer of which of the following structures?

Accepted Answer

Apical lobe of the lung

Answer

Lingula of the lung

Answer

Thyroid gland

Answer

Pyriform fossa

Respiratory Pathology — MCQs

Respiratory Pathology — MCQs

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